Menopause Guide: Dr. Marie Savard Answers Your Questions


Savard answered: Although for many years we believed that many women could benefit from lifelong estrogen treatment, we no longer think this way. Most research suggests that the increased risk of breast cancer is very small if any after the first few years but rises somewhat after 4-5 years on estrogen. On the other hand, once you stop estrogen, progressive bone loss and dry vaginal tissues will continue. Some women try to taper off estrogen slowly after a few years and see how they feel. If hot flashes don't come back, they then stop altogether and use other means to improve their bone strength and minimizes vaginal dryness.

Carolyn asked: Is it normal to have a little spotting ten years after your last period?

Savard answered: It is not normal to have any spotting or bleeding 10 years after your last period unless you are on hormones. If you are on hormones, some typical bleeding pattern or spotting may be seen, but even then you should alert your doctor to your bleeding pattern. Although a common reason for spotting is dry atrophied vaginal tissues and spotting after painful sex, a worrisome cause would be cancer of the lining of the uterus. All women who spot after they go through menopause should have a thorough gynecologic exam and a uterine ultrasound and or uterine biopsy. I have had both and can assure you they provide great peace of mind and can be done in a doctor's office. Only if something suspicious is found will you be advised to have a surgical procedure. Please don't hesitate or be afraid of getting checked out by a gynecologist.

Ann asked: I'm 50 years old. My periods have been irregular and appear to have stopped. My doctor did a blood test and followed up that my hormone levels are consistent with menopause and that if I have any bleeding I should come. I really have no symptoms that are unbearable -- a few hot flashes -- more like small panic attacks. I don't sleep as well at night, etc., but nothing that warrants taking medication for. Do I need to do anything besides my annual checkup, eating right and getting exercise? Also when filling out other forms, such as for an X-ray of my shoulder, how do I answer the question: "Date of last period?"

Savard answered: Not until your period has stopped for 12 months can you say you are definitely in menopause. Your blood test (the FSH test) may be high consistent with menopause, but it is not precise and may still be fluctuating. Until it has been a full 12 months I would answer that you are in the perimenopausal period. So far it sounds like you can avoid estrogen for now. As long as you are living a healthy lifestyle, have good bone density and low heart risk, you don't need to do anything more. Don't forget a colon cancer and breast cancer screen too however. By age 50, all adults need some colon cancer screening.

Kathleen from Pa., asked: I hear all these women my age telling me the problems they are having with menopause. I'm 50 and have no symptoms. I hope this continues. But, maybe I have not started it yet. When does menopause start and how long does it last?

By age 50 your ovaries have surely begun to reduce hormone production however some women have absolutely no symptoms and their period abruptly and permanently stops. Congratulations if that is you. Don't count yourself through menopause until you have gone 12 months without a period.

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